Travel Health

Topic Overview

How can you stay healthy on your trip?

The best
way to stay healthy on your trip is to plan before you go. If you are planning
to travel to another country, see a doctor several months before you leave so
you will have time for vaccines (immunizations) that you may need to get
ahead of time.

Also ask your doctor if there are medicines or
extra safety steps that you should take. For example, if you have asthma, you may have to avoid stays in polluted cities. Or someone visiting the tropics may need to take medicine to prevent
malaria.

Where can you get the best information?

You can
use the Internet to find general travel health information. Just make sure that the
information is up-to-date and from a reliable source. See the following websites before you travel:

Centers for Disease Control and Prevention
(www.cdc.gov/travel): This site has information on travel health and safety, required immunizations, and disease outbreaks.

U.S. State Department (www.usembassy.gov): This site has information on where to get the best medical care in the region you are visiting. It lists every U.S. embassy
worldwide and lists some doctors and medical facilities in those countries. Take along the phone numbers and addresses of embassies in the areas
you will visit.

Rabies, if you may be handling or near animals in parts of the world where rabies is common.

If you plan to visit an area where malaria is common, start taking medicine ahead of time to prevent malaria infection.

What precautions should you take while you travel?

Before you go, learn about the places you plan to visit. For example, find out if the water
is safe to drink or if you need to worry about malaria.

Basic safety can prevent some
problems:

Developing countries may not have safe
tap water. When visiting these places, drink only beverages made with boiled
water, such as tea and coffee. Canned or bottled carbonated drinks are usually a safe choice. Don't use ice
if you don't know what kind of water was used to make it.

Do not eat raw vegetables, raw fruits, or raw
or undercooked meat and seafood.

In malaria-infected areas, use DEET insect repellent. Wear long pants
and long-sleeved shirts, especially from dusk to dawn. Use mosquito netting to protect yourself from bites while you sleep.

Motor vehicle accidents are a leading cause of injury among travelers. If you drive, be sure to learn the custom and rules. If you
use hired drivers (such as in a taxi), don't be afraid to ask your driver to
slow down or to drive more carefully. Use seat belts if possible.

What if you get sick while you are traveling?

If
you become seriously ill while traveling, your country's embassy or consulate
can help you find medical care. If you become ill with a fever or flu-like
illness while traveling in malaria-risk areas, get medical help right
away.

Diarrhea is the most common illness to strike travelers. Most cases of traveler's diarrhea get
better in 1 to 3 days without treatment. But see a doctor if diarrhea lasts
longer than 7 days, or if you have a high
fever, blood or mucus in your diarrhea, or signs of dehydration.

Should you see a doctor when you return?

If you
were healthy during your trip and you feel well when you return home, you
probably don't need to see a doctor.

See your doctor when you get home if either of the following occurs:

You were sick with a
fever or severe flu-like illness while traveling.

You develop these symptoms within 6 months of coming home.

Tell your doctor the places you
visited and whether you think you may have gotten a disease. Many diseases don't show up right away. And some can take weeks or months to develop.

Before You Go

Proper
planning is the best way to stay healthy during your trip. This takes time. You'll want to gather both travel and health information, and think about your special needs.

See a doctor several months before you go so you'll have time to get vaccines or make other health preparations.

To get started

Think about the type of shape you're in. Most travel, even if you are going on a
guided tour, typically demands more physical effort than is
required at home. Boost your fitness by starting an exercise program, such as
fitness walking, in advance.

Make a
first aid kit with items such as pain relievers, sunscreen, insect repellent,
moleskin, antifungal and antibacterial ointments, medicine for motion sickness, and antidiarrheal medicines.

If you have health
insurance, find out
how your insurance works outside of the United States. If your insurance
company doesn't cover you in other countries, you may want to think about buying travel
health insurance. Use the Internet to search for "travel insurance compare" to get websites that help you compare types of travel insurance.

Get the information you need

You can
use the Internet to find general travel health information. Just make sure the
information is up-to-date and from a reliable source. See the following websites before you travel:

Centers for Disease Control and Prevention
(www.cdc.gov/travel): This site has information on travel health and safety, required immunizations, and disease outbreaks.

Centers for Disease Control and Prevention (CDC) Vessel Sanitation Program
(www.cdc.gov/nceh/vsp): This site contains information from the CDC about cruise ship sanitation inspection scores.

U.S. State Department (www.usembassy.gov): Information on where to get the best medical care in the region you are visiting. It lists every U.S. embassy
worldwide and lists some doctors and medical facilities in those countries. Take along the phone numbers and addresses of embassies in the areas
you will visit.

Get needed vaccines and medicines

Check with the
nearest travel health clinic, your regional health department, your doctor, or one of the websites listed above to see what kind of
vaccines you should get. In the United States, most state health clinics can give
you travel vaccines, some medicines, and healthy travel tips.

See your doctor or go to a clinic several months before your trip, or as soon as you can. Some vaccines need to be given in more than
one dose. For example, if you need protection from hepatitis A, you'll need two doses of hepatitis A vaccine spaced at least 6 months apart.

Tetanus(What is a PDF document?), if you haven't received one in the last 10 years.

Hepatitis A(What is a PDF document?), if you are going to developing countries where the disease is common. The
vaccine(What is a PDF document?) is given as two shots. The first hepatitis A shot
usually works in about 4 weeks. It protects most people from getting
hepatitis A. The second shot is given at least 6 months after the
first shot and provides lasting protection.

Typhoid fever(What is a PDF document?), especially if you are traveling
to an area where the risk of typhoid fever is high. These areas include Central
and South America, Africa, and Asia. Your doctor, health clinic, or health
department will have the most recent recommendations.

Rabies(What is a PDF document?), if you may be handling or near animals in parts of the world where rabies is common.

More
immunizations may be needed depending on the area you are visiting, how long
you will be there, and the purpose of your journey. For example, if you will be
trekking in rural Asia for a month or longer, you may need a vaccine for Japanese encephalitis(What is a PDF document?).1

A vaccine for traveler's diarrhea and
cholera, called Dukoral, has been approved in Canada
and Europe. But it is not available in the United States.

Malaria

Ask about a prescription
for antimalarial drugs if you will be visiting an area that has
malaria. This includes large
areas of Central and South America, Haiti and the Dominican Republic, Africa,
the Indian subcontinent, East Asia, Southeast Asia, the Middle East, and many
South Pacific islands.

You may need to take one of several different preventive
medicines, depending on the type of malaria parasite in that part of the world.
These medicines need to be taken daily during your travels and for a specified
time after you return. It is important to take all the tablets you were given.
This may mean taking antimalarial tablets for several weeks after you get home.

Personal health needs

If you have any
chronic diseases or other health concerns, such as birth control or allergies,
see your doctor. You may need to take other steps or make adjustments in your travel plans.

Carry a letter from your doctor describing your conditions, a
list of your routine medicines including their generic names, and written
prescriptions for refills if you will be gone long.

Leave your prescription medicines in the
original containers—your name must match the name on the bottle—and pack them
in a waterproof container in your carry-on luggage. Take extra amounts of your
routine medicines packed in checked luggage in case of theft or loss.

If you have a heart
condition, travel with a copy of your most recent
electrocardiogram (EKG, ECG) for comparison in case you have chest pain or other symptoms.

If you have asthma,
chronic obstructive pulmonary disease (COPD), or other
lung diseases, you may need to avoid stays in polluted cities or at high
altitudes.

If you are pregnant, talk to your doctor before making any travel
decisions. If you decide to travel, take some
general precautions while traveling, such as notifying
the airline of your condition before you fly and taking a few walks while on a
long flight to increase the blood circulation in your legs. (This is good advice for all
travelers.)

Precautions Along the Way

Traveling comes with a
whole new set of things to think about. The following can help you stay healthy
and enjoy your trip as much as possible.

Tips for flying

Flying isn't always fun. But you can take steps to
make it easier and to feel better during and after your flight.

Pack anything that may cause problems at
security—such as gels, liquids, sharp scissors, or pocket knives—in the luggage
you plan to check. For an updated list of what isn't allowed in carry-on
luggage, see the Transportation Security Administration website at
www.tsa.gov/travelers/airtravel/prohibited/permitted-prohibited-items.shtm.

Wear roomy, comfortable shoes that slip on and off. These are
easy to remove when you go through security at the airport. They will also be
more comfortable if your feet swell on the plane.

Water and food safety

Contaminated water and food are the most common cause of illness in
travelers.

Drinking water

Don't drink tap water if it may not have been properly treated.

Don't brush your teeth with tap water.

Drink beverages made with boiled water, such as tea
and coffee. Canned or bottled carbonated beverages (including
bottled water and soft drinks), beer, and wine are also usually safe.

Don't accept ice in drinks. It may be contaminated.

Dry the opening of
wet cans or bottles before taking a drink.

Travelers to backcountry areas of North America
should also take precautions with water. Even though the water in high mountain
lakes looks sparkling clear, it may be contaminated with Giardia intestinalis, the parasite that causes
giardiasis. Take simple
precautions to avoid this illness, such as boiling the
water.

Food

Avoid raw fruits (unless you wash and peel them yourself), raw
vegetables, and raw or undercooked meat and seafood.

Swimming and water sports

Swimming in contaminated fresh water, such as
ponds or rivers, can expose you to diseases. Even swimming pools with
inadequate chlorination pose a risk. Talk to your doctor if you plan on doing
recreational water sports—such as white-water rafting, adventure racing, or
kayaking—in tropical and backcountry regions.

To prevent fungal or
parasitic infections and injuries, do not go barefoot. Try to keep your feet as
clean and dry as possible.

Although sea water is usually safe
from disease, swimming or diving in sea water can still be dangerous. Avoid
swimming or wading in sea water near a river, estuary, or other outlet from
inland. Swimming when you have an open cut or sore can also increase your risk
of getting an infection. In developing countries, sea water around big cities
and other populated areas may not be safe. For more information, see the topic
Marine Stings and Scrapes.

Insect-borne disease

Malaria
is the insect-borne disease of most concern to travelers in tropical and
subtropical regions. Although antimalarial medicines kill the malaria parasite
in the bloodstream, this protection isn't complete. Take protective measures
along with taking antimalarial medicine.

Ticks inhabit many regions, including Europe, Canada, and
the United States. Although it is rare for travelers to
contract diseases from ticks, some of the diseases are serious. For
information on how to prevent tick bites, see the
topic
Tick Bites.

Here are some tips that can help you avoid mosquitoes and other insects:

Sleep under a bed net to prevent insects from biting you while you sleep. Permethrin or
deltamethrin insecticide sprayed on bed nets will protect against mosquitoes
for weeks to months.

Use mosquito coils. The smoke from these slow-burning coils repels mosquitoes.

Wear light-colored and
loose-fitting long pants and long-sleeved shirts. This is especially important from dusk to dawn,
when mosquitoes that spread malaria bite. Insect repellent applied to clothing
is effective for longer than it may be on the skin.

Do not use home remedies like eating garlic, rubbing garlic on your
skin, or taking vitamin B. They do not prevent bites.

Sun and heat exposure

Many travelers underestimate the sun's strength and overestimate the
amount of protection their sunscreen offers. This can add up to at least an
uncomfortable sunburn and other skin damage.

Heat can also cause problems such as heat exhaustion or heatstroke. Sometimes it's hard to keep cool
while you are active in a hot environment. But you can take steps to prevent heat-related illness.

Before you travel to a hot environment, you can improve your ability to handle heat. Start by
exercising for a short time in the heat. Then for the next 2 to 3 weeks, slowly increase the time you exercise in the heat.

If you are not used to the heat, limit the amount of time you are out in the hottest part of the day.

Drink plenty of water. Losing 2% to 3% of your weight through sweat increases your risk of a heat-related
illness.

Do not drink alcohol. It increases your risk for dehydration.

Some medicines can make a heat-related illness more likely. If you take medicines regularly, ask
your doctor for advice about hot-weather activity and your risk for heat-related illness.

Injuries

Although
disease is a big risk while you are traveling, you should also be aware
of the risk of injury.

Motor vehicle accidents. They are a leading cause of injury among travelers. Bad roads, poor driver training, and crowded
roadways can make driving dangerous in other countries.

Learn local driving customs and road signs.

Try to travel during daylight.

Always use seat
belts.

Ask
taxi drivers or other hired drivers to slow down or drive more carefully if you feel unsafe.

Wear helmets and protective clothing when riding
motorcycles or bicycles.

Animal bites. Take care around dogs and other animals. Dogs in developing countries may bite, and
rabies is a concern. If you are bitten by an animal, wash the bite with soap and water and
seek medical attention immediately.

Wounds. Most wounds sustained in
developing countries carry a higher risk of becoming infected. If you get even
a minor wound, clean it as soon as possible with large amounts of warm
water and soap. Apply antibiotic ointment and a bandage.

If you haven't had a
tetanus shot in 10 years, you should get a
booster dose before you leave on your trip. But if you don't get a tetanus shot before you leave, you should get one after an animal bite
or an injury that results in a break in the skin.

Altitude

Altitude sickness happens when you can't get enough
oxygen from the air at high altitudes. This causes symptoms such as a headache
and loss of appetite. The best treatment for altitude sickness is to go to a lower altitude. But if you have mild symptoms, you may be able to stay at the higher altitude and let your body get used to it.

Steps to prevent altitude sickness include eating breads, grains, and pasta and not flying directly from low altitudes to high altitudes. You may also be able to take medicine to prevent altitude sickness.

Scuba diving safety

You will learn about safety in your scuba diving certification class. If
you plan to get certified while traveling, find an experienced, certified
teacher that you feel comfortable with. Several groups, including the
Professional Association of Diving Instructors (PADI) and the National
Association of Underwater Instructors (NAUI), certify instructors and dive
shops all over the world.

If you are a new diver, it is best to go with an
experienced guide, also called a dive master. Most accidents and problems occur
when divers ignore the rules and push their limits. Here are some general diving rules:

Only dive if you feel comfortable.

Use equipment that you are familiar with and that is in good
repair.

Know what to do if something goes wrong.

Always dive with a buddy.

Go down and come up slowly. Don't hold your
breath.

Know and follow recommended depths and time limits.

Allow enough time between your last dive and your flight
home.

Other concerns

The motion of cars, planes, trains, boats, or ships can make some people sick. If you know that you get motion sickness, pack medicines to prevent it.
To learn more, see the topic
Motion Sickness.

Air pollution can pose a serious threat to those with
asthma or other respiratory conditions. When air quality is poor, avoid the area or stay indoors as much as possible.

What to Do if You Get Ill

Serious illness

If you become seriously ill while traveling, your
country's embassy or consulate can help you find medical care. For a complete
list of embassies and consulates, see the U.S. Department of State website at
www.usembassy.gov. You can also get the contacts for local doctors and medical
clinics. If you become ill with a fever or flu-like illness while traveling,
seek medical attention immediately.

Diarrhea

Traveler's diarrhea is the most common illness when traveling. Most cases get better
within 1 to 3 days without medical treatment.

Most doctors recommend trying to keep to your normal diet as much as
possible. If you are vomiting, this may be hard. Try drinking clear liquids.
Watch for signs of
dehydration, such as a dry mouth and dark-colored
urine. If possible, drink
rehydration drinks to replace lost fluids and
electrolytes. Before you go, buy dry packets of oral rehydration mix at a
drugstore.

See a doctor if diarrhea doesn't
subside or if you have a high fever, blood or
mucus in your stools, or signs of
dehydration. Watch closely for
signs of dehydration in children, because children with
diarrhea can quickly become seriously dehydrated.

Your doctor may be able to give you antibiotics to take if you get diarrhea. But some antibiotics can be dangerous if you have bloody diarrhea. Make sure you talk to a doctor before you take antibiotics for bloody diarrhea. And don't take antibiotics to prevent diarrhea.

Antidiarrheal
medicines, such as those containing bismuth (examples include Bismatrol and Pepto-Bismol) or Imodium A-D (nonprescription) and Lomotil (prescription),
give relief from cramping and frequent stools. But you shouldn't take them if
you have a fever or blood or
mucus in your stools.

Post-Travel Care

If you have been healthy during your trip and feel well
when you return home, you don't need to see a doctor. But if you've been ill,
especially while traveling to regions where disease is prevalent, you need to see a doctor.

Many diseases don't show up right
away. Some take weeks to months to develop. For example, 90% of travelers who
get malaria don't become ill until after they return home.2

See your doctor when you get home if either of the following occurs:

You were sick with a
fever or severe flu-like illness while traveling.

You develop these symptoms within 6 months of coming home.

Tell your
doctor the regions you visited and about any exposure to disease.

It's important to be aware of other symptoms besides a fever.
See your doctor if you have:

Diarrhea that won't go away or that keeps coming back.

A
skin rash or sores.

Jaundice (typically most noticeable when the whites of
the eyes appear yellow).

Other Works Consulted

Centers for Disease Control and Prevention (2012).
CDC Health Information for International Travel 2012: The Yellow Book. New York: Oxford University Press. Also available online: http://wwwnc.cdc.gov/travel/page/yellowbook-2012-home.htm.

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How this information was developed to help you make better health decisions.